Supporting healthful behaviour to manage type 2 diabetes in diverse UK Black African and Caribbean adults

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Background: Type 2 diabetes (T2D) is increasing in worldwide prevalence. In the UK there is a disproportionate burden of T2D amongst minority ethnicities; people of Black African or Caribbean heritage are up to three times more likely to develop T2D than the general population. It occurs at a younger age with poorer glycaemic control at diagnosis. The cornerstone of care is diabetes self-management. This involves making dietary changes, increasing moderate to vigorous physical activity, losing weight and taking medication as prescribed. People of Black ethnicity have been shown consistently to have poorer diabetes outcomes than White Europeans. Improving the cultural saliency of care and developing culturally tailored interventions to support diabetes self-management behaviour has been shown to improve outcomes, however, to date in the UK there have been no interventions specifically designed to support those of Black African and Caribbean ancestry. Engagement with medical care and diabetes self-management is influenced by sociocultural factors, such as health behaviour practices, health beliefs and health-related knowledge. Focusing on adults of Black African and Caribbean ancestry with T2D, this study aimed to: 1) understand the contextual sociocultural factors influencing diabetes self-management; 2) explore how these factors shape behaviour; and 3) identify potential intervention targets and associated evidence-based behaviour change techniques (BCTs) to develop theoretical understanding of how to support healthful behaviour in a culturally salient manner.

Methods: This study was nested within the HEAL-D mixed methods study and data were collected from 12 focus groups and 20 interviews (n=67). Each was audio-recorded and transcribed. Grounded theory methods were used to explore the interplay of influencing factors on self-management behaviour from the perspective of those living with diabetes. A behaviour change theoretical framework (COM-B and the behaviour change wheel) was then applied to the data to determine potentially helpful evidence-based BCTs.

Results: The novel theory Integrating Perspectives highlights that individuals experience misalignment between the lay and medical perspectives. Cultural identity, biomedical knowledge and inter-relational trust with healthcare professionals influenced the extent of the misalignment and were key determinants of self-management behaviour. Individuals reconciled the two perspectives by information seeking and filtering out recommendations that conflicted with cultural identity to varying degrees. Four behaviour patterns were identified: Adaptation, Accommodation, Traditionalism and Detachment. The BCTs identified to address determinants of behaviour included demonstration, instruction, social support, and credible sources. Furthermore, involving community networks in supporting self-management showed potential for supporting the provision of culturally situated knowledge and social support.

Conclusions: This study adds to our theoretical understanding of how sociocultural factors shape diabetes self-management in UK Black African and Caribbean adults and how these factors may be leveraged to support self-management. Identification of evidence based BCTs to address these factors can inform the theoretical development of culturally tailored health promotion materials and interventions. These findings are likely to be of value to clinicians, health promotion designers and researchers in this field.
Date of Award1 Sept 2022
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorLouise Goff (Supervisor)

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